The Hyde and Helms amendments, which restrict the use of federal funds for abortion services under domestic programs and in foreign assistance, respectively, are harmful to women in myriad ways, according to two new Guttmacher policy analyses. The articles discuss recent and potential future steps to soften some of the impact of these restrictions, but conclude that, to protect the health and redeem the full human rights of women in the United States and overseas, all restrictions on U.S. abortion funding and insurance coverage must eventually be repealed.

“Looking at the impact of funding restrictions at home and abroad, there are several common themes,” says Heather Boonstra, author of the domestic analysis. “The poorest and most vulnerable women are usually hit hardest, leaving some of them unable to obtain a safe and legal abortion. This can have dire consequences for women and their families—for instance, forcing them to carry an unwanted pregnancy to term or, as is the case in many developing countries, compelling them to seek a clandestine abortion that can result in serious injury or death.”

“Another overarching impact of funding restrictions is that they single out and stigmatize abortion care,” says Sneha Barot, who analyzed the Helms amendment’s impact on U.S. foreign assistance programs. “This stigma has a chilling effect, often leading various actors—from administrators to health service providers on the ground—to shy away even from abortion-related activities that are clearly permissible under these restrictions.”

The harmful impact of restricting abortion funding in U.S. foreign assistance

The 1973 Helms amendment prohibits payment for “abortion as a method of family planning” in U.S. foreign assistance programs. However, Barot argues that the law has been interpreted too broadly as a blanket prohibition of funding abortion services and that a correct reading of the law would allow support for abortion in certain cases.

“The administration has the power to moderate the impact of Helms in a small but significant way without the involvement of Congress, by allowing foreign aid funding to be used for abortion services—where legal—for women who experience rape, incest or a life-threatening emergency,” says Barot. “In none of these instances would an abortion be performed as a ‘method of family planning.’ Further, a more narrow interpretation would bring Helms in line with the federal status quo on abortion restrictions, as well as the current political consensus among both Congress and the American electorate.”

Almost all federal programs that restrict abortion funding—including Medicaid, the Indian Health Service, health care for servicewomen and military dependents, and the Federal Employees Health Benefits Program—make explicit exceptions for the extreme cases of rape, incest and life endangerment. The rationale for a revised and corrected policy on Helms implementation stands on solid ground on all accounts—from a public health, legal and even political basis, according to Barot.

“This modest but critical step in reforming U.S. abortion policy overseas could help diminish the hostile climate toward abortion long associated with the United States,” says Barot. “It would make U.S. policy more humane and could make a real difference in the lives of women finding themselves in a desperate situation.”

The harmful impact of domestic abortion coverage restrictions

The Hyde Amendment bans federal funding for abortion, except in cases of rape, incest and life endangerment. It primarily impacts poor and low-income women enrolled in Medicaid, who often suffer severe hardships to raise the money for an abortion. Research shows that one in four Medicaid enrollees who want to terminate an unwanted pregnancy are unable to do so because they can’t come up with the necessary funds.

“The Hyde Amendment is a pernicious law that explicitly targets the poorest and most vulnerable women,” says Boonstra. “It’s a matter of perverse irony that even more women will be subject to the Hyde amendment starting in 2014 when the health care reform law’s Medicaid expansion goes into effect. And many women who will purchase private insurance coverage on the new health insurance exchanges may well be ensnared by Hyde-like restrictions as well.”

Under health care reform, federal subsidy dollars for individuals purchasing plans on the health insurance marketplaces (scheduled to be operational this fall) may not be used to pay for abortion coverage, except in cases of life endangerment, rape or incest. It will quickly become clear how insurance plans are positioning themselves and to what extent the new norm regarding abortion coverage is veering toward exclusion, rather than inclusion, according to Boonstra.

“Both for public and private insurance coverage of abortion, things are moving in the wrong direction for U.S. women,” says Boonstra. “Abortion is a legal, constitutionally protected and medically appropriate health care service. It’s time to reverse course so that every woman has affordable and comprehensive coverage that includes coverage for abortion care.”

Read the full analyses here:

Abortion Restrictions in U.S. Foreign Aid: The History and Harms of the Helms Amendment,” by Sneha Barot

Insurance Coverage of Abortion: Beyond the Exceptions For Life Endangerment, Rape and Incest,” by Heather D. Boonstra

For more information:

Facts on Induced Abortion in the United States
Video on Abortion in the United States
Infographics on Abortion in the United States
Facts on Induced Abortion Worldwide
Video on Abortion Worldwide
State Policies on Public Funding of Abortion
State Policies on Insurance Coverage of Abortion

Also in this issue of Guttmacher Policy Review:

"Title X: An Essential Investment, Now More than Ever," by Kinsey Hasstedt;

For the Record, "Physicians' Groups Respond to TRAP Laws Passed During 2013 Legislative Session."